Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania.
Reference Centre for Oncohaematological Diseases at the Haematology, Oncology and Transfusion Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania.
Medicina (Kaunas). 2023 May 24;59(6):1008. doi: 10.3390/medicina59061008.
Acute lymphoblastic leukaemia (ALL) is associated with a cytokine imbalance and oxidative stress, which can be aggravated by malnutrition. Malnutrition, defined by the World Health Organisation (WHO) as obesity or undernutrition, can affect treatment complications and outcomes. Therefore, we aimed to analyse the change in the body mass index (BMI) -score during induction, as well as evaluate the impact of childhood malnutrition on fevers at an ALL presentation and early response to therapy. : An observational cohort study of 50 consecutive children with ALL, diagnosed in 2019-2022, was performed. Patients were divided into age groups of 0-5, 6-11, and 12-17 years. BMI-for-age -scores were used to define undernutrition and overnutrition according to WHO growth standards. The number of patients with an abnormal BMI increased from 3 (6%) at diagnosis to 10 (20%) at the end of induction (from 2 (4%) to 6 (12%) in overweight/obese, and from 1 (2%) to 4 (8%) in underweight patients). At the end of induction, all overweight/obese patients were 0-5 years old. On the other hand, a statistically significant decrease in the mean BMI -score among patients aged 12-17 was observed ( = 0.005). The mean BMI -score differed statistically significantly among children aged 0-5 presenting with and without fever ( = 0.001). The minimal residual disease (MRD) level at the end of induction was not related to BMI at diagnosis. : Despite the use of steroids, adolescents are prone to losing weight during an ALL induction, in contrast to preschool children, who tend to gain weight under the same treatment. BMI at diagnosis was related to a fever of ≥38 °C (at ALL presentation) in the 0-5 age group. The results emphasise the importance of careful nutritional status monitoring, with younger and older children as important target groups for weight gain and weight loss interventions, respectively.
急性淋巴细胞白血病（ALL）与细胞因子失衡和氧化应激有关，营养不良会加重这种情况。世界卫生组织（WHO）将营养不良定义为肥胖或营养不足，它会影响治疗并发症和结果。因此，我们旨在分析诱导期间体重指数（BMI）评分的变化，并评估儿童营养不良对 ALL 发病时发热和早期治疗反应的影响。
这是一项对 2019 年至 2022 年间诊断的 50 例连续 ALL 患儿进行的观察性队列研究。根据 WHO 生长标准，使用 BMI-年龄评分来定义营养不良和营养过剩。诊断时，有 3 名（6%）患者的 BMI 异常，到诱导结束时增加到 10 名（20%）（超重/肥胖患者从 2 名（4%）增加到 6 名（12%），消瘦患者从 1 名（2%）增加到 4 名（8%））。在诱导结束时，所有超重/肥胖患者均为 0-5 岁。另一方面，12-17 岁患者的平均 BMI 评分显著下降（ = 0.005）。0-5 岁发热和无发热患者的平均 BMI 评分存在统计学差异（ = 0.001）。诱导结束时的微小残留病（MRD）水平与诊断时的 BMI 无关。
尽管使用了类固醇，但青少年在 ALL 诱导期间容易体重减轻，而学龄前儿童在接受相同治疗时体重往往会增加。诊断时的 BMI 与 0-5 岁组≥38°C 的发热（在 ALL 发病时）有关。结果强调了仔细监测营养状况的重要性，对于年幼和年长的儿童，分别是体重增加和体重减轻干预的重要目标群体。
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